More Questions for Uncovering Suicidal Ideation and Reflected Intent

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More Questions for Uncovering Suicidal Ideation and Reflected Intent

â€œFor only by confronting the issues that bedevil us when we confront the finality of death can we start to understand the darkness in ourselves.â€

Ellen Datlow Editor, The Dark: New Ghost Stories

More Questions for Uncovering Suicidal Ideation and Reflected Intent

TISA Description of the Problem: Uncovering the amount of thinking about suicidal planning and the amount of action taken on it may be a better reflection of the clientâ€™s actual intent than what the client claims his or her intent to be. There are many reasons, from stigmatization to fear of ramifications (unwanted hospitalization) to a pervasive desire to actually kill oneself, for not sharing oneâ€™s true intent. Such indirect indicators of actual intent have been called â€œreflected intent.â€ (see article below) There are many practical nuances to this concept, that I think may help us to save a life. I was recently fortunate to have the Psychiatric Times ask me to describe these practical nuances in a short article called: Suicide Assessment â€” Part 1: Uncovering Suicidal Intent â€” A Sophisticated Art. It describes a concept called the â€œEquation of Suicidal Intentâ€. I hope you and your trainees will find it useful, and you can find it posted on the web for free at: www.psychiatrictimes.com/display/article/10168/1491291

In this light, Bernie Gottschalk, Ph.D. shares three very nice clinical interviewing tips that can help one to better understand the amount of reflected intent that may have surrounded a recent overdose. See what you think.

Tip: I am sometimes surprised at how much suicidal ideation clients are withholding. The following three questions often open up some secrets about an overdose:

TISA Follow-up: All sorts of useful material, that may better reflect the clientâ€™s true suicidal intent, can surface with these simple yet effective interviewing techniques provided by Bernie. For instance, the clientâ€™s answer as to why he or she chose a particular pill to take may give excellent insight into how much he or she wanted to actually die (e.g. The client chose aspirins – potentially very lethal – over some stored up antibiotics – much less lethal).

I hope that you enjoyed these tips and will enjoy the short article on â€œreflected intentâ€ as you continue your efforts to fine-tune and to teach the art of clinical interviewing.